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Association of ANCA associated vasculitis and rheumatoid arthritis: a lesser recognized overlap syndrome

Draibe, J; Salama, AD; (2015) Association of ANCA associated vasculitis and rheumatoid arthritis: a lesser recognized overlap syndrome. SpringerPlus , 4 , Article 50. 10.1186/s40064-015-0835-8. Green open access

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Abstract

Background ANCA associated vasculitis (AAV) is an autoimmune disease with significant morbidity and mortality, in which diagnostic delay is associated with worse outcomes. AAV is rarely found in association with other immune mediated diseases. Early recognition of such overlaps enables more timely diagnosis and may impact on disease outcome. We reviewed cases of AAV in which there was an overlap with rheumatoid arthritis (RA). Methods We performed a retrospective analysis of our vasculitis database for patients who had a diagnosis of AAV and RA, and a literature search to find other reported cases of this overlap syndrome. Results We found six subjects who had a diagnosis of RA and developed AAV at a median of 10.5 years (range 4–43 years) after the diagnosis of RA. They had been treated with a mean of 2 disease modifying drugs (0–4) and all had evidence of renal involvement with median creatinine of 227 μmol/l (range 128–700 μmol/l). Only one had a diagnosis of granulomatosis with polyangiitis, while the rest had a clinical diagnosis of microscopic polyangiitis. Half of the patients had positive rheumatoid factor (RhF) at the time of vasculitis diagnosis, three had MPO-ANCA, one PR3-ANCA, and two had ANCA-negative pauci-immune vasculitis. Additionally, we found 29 other cases reported of this overlap, which also most frequently presented with vasculitic renal manifestations, and were frequently RhF positive at the time of AAV diagnosis. Conclusions AAV occurs in subjects with RA rarely, and often with significant delay from the first rheumatological manifestations. Renal involvement is common

Type: Article
Title: Association of ANCA associated vasculitis and rheumatoid arthritis: a lesser recognized overlap syndrome
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/s40064-015-0835-8
Publisher version: http://dx.doi.org/10.1186/s40064-015-0835-8
Language: English
Additional information: © 2015 Draibe and Salama; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
Keywords: Rheumatoid arthritis; ANCA associated vasculitis; Overlap syndromes
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Renal Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/1470821
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